tbuckley/cabot-search huggingface dataset:
DS26 Review of 2-week suspected skin cancer activity shows a large increase in number of patients with basal cell carcinoma: implications for designing services and workforce planning
Authors: Julia Schofield, Krisztina Scharrer, Kimberley Millbank
Journal: British Journal of Dermatology (2023)

Abstract The 2-week wait (2WW) suspected skin cancer referral pathway is for people with high-risk skin cancers in particular squamous cell carcinoma (SCC) and malignant melanoma (MM) but not for most basal cell carcinomas (BCC). Conversion rates reflecting the number of SCC and MM diagnosed via a 2WW pathway are around 8–12%. Prior to the COVID-19, pandemic people with straightforward low-risk BCCs would be referred on a routine pathway with an expectation that their management would be completed within 18 weeks. The postpandemic pressure on routine waiting lists has meant that managing patients with BCC in a timely fashion is challenging, and the impression is that these patients are now being referred on the 2WW pathway to avoid delays in treatment. The aim of this study was to review the 2WW referral activity between 2019 and 2022, particularly in relation to the number of patients with BCC. Data were obtained from the cancer team (Table 1). There has been a 68% increase in 2WW referral activity. The proportion of people discharged at first attendance and the MM and SCC conversion rate has remained fairly stable. Looking specifically at BCCs, there was an increase from 13.7% to 16.2%. The total number of tumours managed increased overall by 85% over the study period (Table 1). For BCC, the activity has doubled from 552 to 1108 patients (to the end of November 2022). These data confirm the large increase in the number of patients referred on the 2WW suspected skin cancer pathway. Although there is little change in the proportion of patients with different types of skin cancer being seen and managed, the total numbers reported here demonstrate a significant knock-on impact of additional workload for specialist teams, including the need for more skin surgery activity, histopathology and specialist skin cancer nursing services. This needs to be considered when developing skin lesion diagnostic and management pathways and confirms the importance of developing locally agreed BCC pathways and defining workforce requirements.Table 1Two-week wait (2WW) referral activity between 2019 and 2022Number of tumours managed2019202020212022 (to the end of November 2022)2WW referrals (n)4038480260636837Discharged at first attendance (%)56505454Melanoma (%)2.32.221.8SCC (%)5.98.47.65.8Conversion rate (SCC and MM) (%)8.210.69.69.6BCC (%)13.713.816.516.2Number of tumoursSCC237403461395Melanoma93104121124BCC5526629981108Total882116915801627
BT05 Community and Locality Imaging Centres: innovation in the skin cancer care pathway
Authors: Shareen Muthiah, Andrew Coon, Alyson Bryden, Gillian Chin, Colin Fleming, Colin Morton
Journal: British Journal of Dermatology (2023)

Abstract Timely management of patients referred with suspected skin cancer remains challenging due to demand that exceeds the capacity of dermatology departments. Encouraging the attachment of images and key metadata along with referrals from primary care helps promote enhanced clinical referral triage. We describe the process of establishing Community and Locality Imaging Centres (CLICs) that seek not only to promote efficient triage, but also to establish a national pipeline of anonymized images, with linked Digital Imaging and Communications in Medicine (DICOM®) data, to assess the potential for future use of artificial intelligence (AI) algorithms in clinical practice. General practitioners (GPs) can request a CLIC appointment at the time of referral, removing the time pressure and potential technical barriers associated with photography and image attachment. Each centre follows the same standardized image capture and hardware operating procedure, ensuring that high-quality, in-focus digital images are consistently acquired. The CLIC appointments take an average of 15 min, during which a suitably trained healthcare professional obtains written patient consent and, using a National Health Service-approved mobile phone with a dermatoscope attachment, takes paired macroscopic and dermoscopic views of each lesion. Relevant metadata, in line with the recently agreed DICOM standards for dermatology, are recorded for individual lesions, enhancing the utility of each photograph. Paired images and metadata are regularly archived to a secure medical image management system and are linked with the referral, allowing dermatologists to perform enhanced clinical triage and communicate one of the following outcomes directly to the referring GP: routine dermatology appointment, urgent dermatology appointment, direct to biopsy or benign lesion–reassurance and discharge. This process aims to streamline the primary care referral pathway and promote immediate benefits to patient care by reducing unnecessary travel for face-to-face outpatient appointments. The establishment of CLICs in Scotland supports referral optimization by providing an efficient, convenient option for GPs and patients to obtain high-quality clinical photography. This model allows for flexible integration into local services: hospital-based with medical photographers, intermediate secondary care-led centres or community-based primary care hubs. Suspected skin cancer referrals can be efficiently triaged by dermatologists when paired with macroscopic and dermoscopic images and relevant patient metadata compliant with DICOM standards. The same images and metadata, once anonymized, can be securely transferred to a nationwide database for deep learning AI algorithm development. Validated AI programs, with the aim of being deployed at the primary care level, inform opportunities for further enhancement of the referral pathway.
PS10 Can an aerobic exercise intervention for patients with psoriasis improve health outcomes and support lifestyle behaviour change?
Authors: Rory Sheppard, Wei Kiat Gan, Gladys Onambele-Pearson, Helen Young
Journal: British Journal of Dermatology (2023)

Abstract Patients with psoriasis do not exercise to the extent recommended for cardiovascular health, due to significant disease-specific barriers, which may augment their increased risk of CVD and metabolic syndrome. Therefore, we developed a bespoke, evidenced-based exercise programme for patients with psoriasis, hypothesizing that it may have utility in the management of psoriasis. Eight patients with psoriasis (32.5 ± 12.02 years old, BMI 26.7 ± 3.3 kg m-2) completed a 20-week physical activity intervention. The first 10 weeks of the intervention comprised two walking sessions per week. Each session was of 1h duration and led by a sports-scientist for small-groups of patients with psoriasis. The volume of exercise per session was calculated so that participants would incrementally progress to heart-healthy levels of exercise over the programme. During weeks 10–20 of the programme, participants engaged in independent activities. Warm-ups, pre-exercise stretching, and cool-downs were incorporated into each of the sports-scientist led sessions. Step counts were recorded using a Newfeel Onwalk 900 pedometer throughout the study. Measurements at pre-, mid-, and post-intervention endpoints (week 0, 10 and 20) included assessment of (i) psoriasis: Psoriasis Area and Severity (PASI); Physicians Global Assessment (PGA); (ii) quality of life: Dermatology Life Quality Index (DLQI), Short Form 36 (SF-36); and (iii) cardiometabolic disease/risk – pulse wave velocity (PWV); blood pressure (BP); body weight and BMI. In addition, cardiorespiratory fitness (CRF) was assessed by: 30-s sit-to-stand (30STS); timed up and go (TUG); single leg balance (SLB); static body-weight wall-squat (SBWS); and step count. Recruitment to the study is ongoing. We observed a significant reduction in both Psoriasis Area and Severity Index and systolic BP at the weeks 10 and 20 timepoints (P &amp;lt; 0.05). We also observed a statistically significant improvement in the SF-36 mental health domain between the weeks 10 and 20 timepoints (P = 0.035). The CRF statistically significantly improved across the duration of the study, with a statistically significant improvement in exercise performance, as evidenced by 30STS, TUG and pedometer step counts at week 10 (P &amp;lt; 0.05), SLB between baseline and week 20 (P = 0.043) and SBWS performance across all timepoints. Exercise induces health benefits, including reduced skin inflammation and systolic BP, and increased CRF, and may improve some aspects of quality of life in those with psoriasis. The impact of lifestyle on psoriasis warrants further investigation. Our data suggest that exercise could represent an adjuvant therapy in the future management of psoriasis.
BI16 (P41) An emerging role of interferon-targeted therapy for the treatment of cutaneous systemic lupus erythematosus: a prospective real-world evaluation of anifrolumab for refractory cutaneous lupus
Authors: Lucy Carter, Zoe Wigston, Philip Laws, Edward Vital
Journal: British Journal of Dermatology (2023)

Abstract Cutaneous lupus erythematosus (CLE), particularly discoid lupus erythematosus (DLE), is frequently unresponsive to standard therapies, including antimalarial and immunosuppressive therapies. Recent evidence has identified the importance of type-1 interferon (IFN-1) in the pathogenesis of disease. Anifrolumab is a monoclonal antibody that targets IFN-1 and has been licensed for the treatment of systemic lupus erythematosus (SLE). It is unclear which clinical subtypes of CLE are associated with an IFN-1 signature and may be responsive to anifrolumab therapy. We sought to evaluate the efficacy of anifrolumab on (i) DLE and (ii) rituximab-refractory CLE; and (iii) to compare IFN-specific biomarkers and (iv) early and late immunophenotypic and clinical responses. Anifrolumab was available through an early access to medicines scheme. Patients with SLE for whom the phenotype was predominantly cutaneous were treated with anifrolumab 300 mg intravenously every 4 weeks. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Dermatology Life Quality Index (DLQI) were reported. Seven patients were enrolled (five with DLE, one with chilblain and one with subacute CLE). All patients were female (median age 46 years; median disease duration 17 years). The median number of failed therapies was six: rituximab in six, belimumab in two and thalidomide in four patients. Four patients required long-term oral prednisolone &amp;gt; 10 mg daily. Median baseline CLASI activity score was 17 and DLQI was 16/30. Median CLASI score reduced after 4 weeks to 6 (range 0–13; P = 0.016) with a median decrease from baseline of 60% (range 19–100%), which was maintained at 6 months. Clinical responses were associated with significant improvements in DLQI (P &amp;lt; 0.001) and EQ-5D visual analogue scale (P = 0.002) by 3 months. All patients had a marked suppression of IFN-stimulated genes at 4 weeks (mean difference 2.92; P &amp;lt; 0.01). Treatment was generally well tolerated with the exception of one patient who had shingles complicated by sensorineural hearing loss while on anifrolumab and prednisolone &amp;gt; 15 mg daily. This required prolonged aciclovir for effective management. This case series highlights the potential role for anifrolumab in managing treatment-resistant CLE with particular responses observed in DLE and chilblain lupus. The need for enhanced awareness of viral infections, particularly varicella-zoster virus, needs to be considered in higher-risk patients.
BI24 Cutaneous pseudolymphoma secondary to pembrolizumab
Authors: Hareni Srenathan, Jing Gao, Eva Kolson Kokohaare, Ferina Ismail
Journal: British Journal of Dermatology (2023)

Abstract A 35-year-old man presented with a 7-week history of itchy, nontender, indurated erythematous plaques and nodules on his forehead and upper back, with no discriminatory clinical features. He was systemically well. Three months previously, he had completed a 12-month course of adjuvant pembrolizumab for stage IIIC melanoma. The primary melanoma had been excised from his left cheek, with involvement of left parotid and supraclavicular lymph nodes, treated with clearance via superficial parotidectomy and left neck dissection. Clinical and imaging surveillance revealed no evidence of melanoma recurrence. Incisional biopsies of the lesions on his back and forehead both demonstrated a superficial and deep dermal perivascular and periadnexal infiltrate of small- and medium-sized lymphoid cells. There was no epidermotropism and B- and T-cell clonality studies were negative. Morphological appearance and immunophenotype favoured a CD4+-reactive lymphoid process in keeping with cutaneous pseudolymphoma (CPL), secondary to pembrolizumab. The conspicuous forehead lesion was unresponsive to clobetasol propionate under occlusion. A single course of intralesional triamcinolone acetonide 10 mg mL–1 resulted in significant improvement within days, with subsequent complete resolution. The lesion on the back resolved spontaneously. Drug-induced CPL describes an adverse cutaneous drug reaction mimicking B- or T-cell lymphomas clinically and/or histologically. It has been described with anticonvulsants, antidepressants and biologic agents, often with resolution on cessation of the responsible drug (Etesami I, Kalantari Y, Tavakolpour S et al. Drug-induced cutaneous pseudolymphoma: a systematic review of the literature. Australas J Dermatol 2023; 64:41–9). It has been proposed that the drugs affect immune surveillance, leading to an abnormal cutaneous lymphocyte response. A case report (Ayoubi N, Haque A, Vera N et al. Ipilimumab/nivolumab-induced pseudolymphoma in a patient with malignant melanoma. J Cutan Pathol 2020; 47:390–3) has described drug-induced CPL secondary to ipilimumab and nivolumab in a 38-year-old man presenting with erythematous plaques on the hands and face, similar to the presentation of our patient, which responded to prednisolone. As with the other adverse effects of immunotherapy, it is likely that CPL in this cohort is due to an iatrogenic immune dysregulation leading to T-cell overactivity. We present the first reported case of CPL secondary to pembrolizumab and highlight the successful use of intralesional steroid as a treatment option. It is important to recognize CPL as an adverse cutaneous effect of immunotherapy and be aware that it can present after completing treatment due to an ongoing immune response.
DS18 Efficacy of intralesional sodium tetradecyl sulfate in pyogenic granuloma
Authors: Sinu Mathachan
Journal: British Journal of Dermatology (2023)

Abstract Data on sclerotherapy in pyogenic granuloma (PG) are sparse and limited to a few case reports and series (Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol 2019; 58:642–8). We present a series of 18 patients with PG treated with intralesional sodium tetradecyl sulphate (STDS). The aim of this study was to evaluate the efficacy, safety and recurrence rates of STDS sclerotherapy in the treatment of PG. Eighteen patients with PG (based on history and clinical features) of any age consenting to be part of the trial were included. Intralesional STDS 1% was injected slowly using an insulin syringe until the lesion blanched, and a maximum of 1 mL was used in one sitting. Patients were followed-up weekly; if the lesion did not show complete resolution, repeat injections were given up to a maximum of three sittings. A final assessment for relapses was done at 4, 8 and 16 weeks after treatment completion. All patients had complete clearance (100%) of the lesions with STDS 1% in one or two sittings. Noted side-effects included pain (n = 6), oedema (n = 4), purpuric staining (n = 2), paraesthesia (n = 1), ulceration (n = 2), necrosis (n = 2) and urticarial rash (n = 1). All side-effects resolved completely; two patients had to take analgesics and oral antibiotics. No bleeding episodes occurred in any patient after the first sitting. Further, none has shown recurrence over a follow-up period of 4 months. Eight patients developed mild atrophic scars as post-treatment sequelae. Sclerotherapy is a simple procedure; however, surprisingly, the literature on its use in PG, a very suitable indication for sclerotherapy by virtue of the pathology involved, is sparse. In this study, STDS successfully cleared the lesions in all patients without major complications or recurrence.
P96 Nutrition in dermatology practice: an unmet need for both patients and healthcare professionals
Authors: Katie Lockwood, Sukhjit Dhariwal, Wendy Hall, Rachel Gibson, Christopher Griffiths, Alia Ahmed, Thiviyani Maruthappu
Journal: British Journal of Dermatology (2023)

Abstract The role of diet and nutrition in the management of chronic inflammatory skin conditions such as eczema, psoriasis and acne is one of the commonest questions asked by patients. Despite this, there is little guidance or training to help healthcare professionals provide disease-specific evidence-based recommendations to patients. Furthermore, growing evidence supports the role of diet and nutrition in the management of skin conditions such as psoriasis and atopic eczema. We sought to explore dermatology professionals’ experiences of patients’ dietary habits in an outpatient setting. We circulated a questionnaire to members of the British Dermatological Nursing Group and the British Association of Dermatologists. We collected demographic data, along with information on how frequently professionals were asked about diet by patients, how confident they felt responding to questions and concerns expressed regarding dietary restrictions, and whether dietitian input or nutrition training would be of benefit to their practice. Three of the authors received funding from the Psoriasis Association. We received 95 responses from dermatology nurses and 64 from doctors. Over 60% of respondents held senior positions with over 10 years of experience. Almost 100% of respondents reported being asked about diet by patients and 73.1% did not feel confident when answering these questions. Patients were most commonly asked about nutrition in relation to inflammatory conditions such as eczema (95.3%), acne (95.3%) and psoriasis (76.6%). All doctors and 97.8% of nurses reported having experienced patients restricting their diet without supervision, and the majority expressed concerns about such dietary modifications. Dairy, gluten and refined sugar were the most commonly excluded foods. Professionals also reported that patients admitted to following restrictive diets and undertaking ‘food intolerance testing’ that they had encountered online. Over 90% of respondents felt that additional nutrition training and access to specialist dietician support would be of benefit to dermatology practice. Dermatology professionals are frequently asked about nutrition and the role of diet yet often lack confidence in responding to these enquiries. Dermatology patients appear vulnerable to dietary misinformation presented online regarding ‘intolerance tests’, and this has the potential to worsen with ongoing delayed access to secondary care. There are also concerns regarding unsupervised restrictive diets, which can negatively impact patients’ mental health and predispose to eating disorders and nutritional deficiencies. Specialist nutrition training for dermatology professionals and the support of dietitians in the clinical setting would help address this unmet need and provide holistic patient care.
P99 Skin disease in people living with HIV in the UK: a retrospective analysis
Authors: Jamie McCluskey, Louis Hickling, Collins Iwuji,, David Chandler
Journal: British Journal of Dermatology (2023)

Abstract The spectrum of skin disease associated with advanced HIV infection is well described and can vary between countries, potentially as a result of genetic differences and access to antiretroviral treatment (ART). Effective ART has modified the skin manifestations of HIV in the modern era. The aim of this study was to characterize the profile of skin disease in a UK-based population of people living with HIV (PLHIV). A retrospective review of inpatient admission records was conducted of all patients admitted to a tertiary hospital between June 2020 and October 2022. Data were collected using a standardized data extraction form in Microsoft Excel. Descriptive analysis was undertaken within Excel. Ninety-seven patients were identified (median age 55 years), of whom 82 (85%) were male. Median duration of HIV infection was 15 years [interquartile range (IQR) 8.66–19.58], with a median duration on ART of 9 years (IQR 3–16). Fourteen patients were ART naïve and were diagnosed as being HIV positive on admission. Median CD4 count at presentation was 351 × 106 cells L−1 (IQR 136–579). Fifty-five patients presented with a single dermatological condition, 30 presented with 2 and 10 presented with 3. Of the conditions identified, 48% were skin infections, 18% were skin tumours, 10% were inflammatory dermatoses and 2.8% were drug reactions. In the remaining 21%, the diagnosis was unknown; this included rashes (44%), skin lesions (33%) and ulcers (22%). The most common dermatological condition identified was cellulitis (n = 18; 19%). Of the infections seen, 46% were primary bacterial infections, 27% were primary viral infections, 22% were primary fungal, 3% were primary parasitic and 1% were systemic bacterial infection with skin involvement. Ten per cent of patients presented with Kaposi sarcoma, an AIDS-defining illness. Of the 97 patients, 27% presented with advanced HIV (CD4 &amp;lt; 200 × 106 cells L−1). The most common conditions in this group were oral candidiasis (30%), cellulitis (15%), seborrhoeic dermatitis (15%) and Kaposi sarcoma (15%). Bacterial skin infections were the most common dermatological conditions overall, while oral candidiasis was the most common condition in those with advanced HIV. The causes of almost one-quarter of dermatological presentations were unknown during inpatient admission, highlighting the importance of expert dermatological input. Further work is needed to validate these findings in a larger population of PLHIV, including those managed in an outpatient setting.